CPT® Code 33902

1. Indications

The procedure of percutaneous pulmonary artery revascularization by stent placement is indicated for the following conditions:

• Stenotic Lesions Stenotic lesions of the pulmonary artery that have not achieved satisfactory results from balloon angioplasty.
• Abnormal Connections Situations involving abnormal vascular connections, such as those found in congenital heart defects or surgically altered anatomy.
• Congenital Defects Patients with congenital defects requiring intervention to improve pulmonary artery blood flow.

2. Procedure

The procedure involves several critical steps to ensure successful stent placement in the pulmonary artery:

• Access Site Preparation The procedure begins with the application of lidocaine to the access site, typically a large vein, which is then punctured to gain vascular access. A guidewire and introducer sheath are placed in the vein to facilitate the advancement of the catheter.
• Catheter Advancement A catheter is advanced over the guidewire to the target area within the pulmonary artery. Initial diagnostic angiograms are performed to measure the stenotic lesion and assess the surrounding vessels.
• Stent and Balloon Selection Based on the angiographic measurements, the appropriate size stent and balloon are selected for the procedure.
• Guidewire Exchange The angiogram catheter is exchanged for an end-hole catheter with a soft guidewire, which is advanced just beyond the lesion. This soft guidewire is then replaced with a stiffer, interventional guidewire to facilitate stent delivery.
• Stent Preparation The stent is prepared and mounted on the delivery balloon. The introducer sheath in the vein is exchanged for a delivery sheath, which is advanced over the stiff guidewire to the target area just past the pulmonary artery lesion.
• Stent Positioning The stent on the delivery device is advanced to the tip of the delivery sheath. Once positioned across the lesion, the delivery sheath is partially withdrawn to perform an angiogram for position verification. Adjustments are made as necessary until optimal placement is achieved.
• Stent Deployment The delivery sheath is completely withdrawn, and the balloon is deployed to deliver the stent. Following deployment, the delivery balloon is removed, and a larger pressure balloon may be advanced over the wire and inflated to dilate the stent to the appropriate diameter.
• Post-Deployment Assessment A diagnostic catheter is exchanged for the balloon to assess the results, stent position, and determine if further intervention is needed. Finally, all instruments are removed, and hemostasis is maintained at the access site.

3. Post-Procedure

After the procedure, patients are monitored for any complications and to ensure proper recovery. The expected recovery period may vary based on individual patient factors and the complexity of the procedure. Careful observation is necessary to assess the effectiveness of the stent placement and to identify any potential need for further interventions. Follow-up imaging may be required to evaluate the stent's position and the patency of the pulmonary artery. Additionally, appropriate post-procedure care should be provided to manage any discomfort and to ensure the patient's overall well-being.